05/03/2024    Rod Tomczak, DPM, MD, EdD

The Future of Podiatry (Ivar E. Roth, DPM, MPH)

In the current debate concerning direct pay for
services rendered versus acceptance of insurance
and being a provider, two thoughts trouble me
greatly from a meta-ethical point of view. I have
tried to find a redeeming tone in each of them and
have delayed responding to ensure I am not just
shooting from the hip. The implications of these
two statements are to say the least profound,
especially for our podiatric students and younger
more impressionable readers.

Dr. Roth, who was among the the first podiatrists
to switch to a fee-for-service medical
reimbursement system claims that it works for him
because he provides the best care possible to his
pay for service patients. In order to be
successful, he must provide these cash patients,
“… great service and great professional care.”

Dr. Roth goes on to say, “No one in their right
mind is going to pay you to do something that
every other doctor down the street can do.” Is he
insinuating that he performs better care because
he does what he does for cash at time of service,
or does he mean that those practitioners who
accept insurance are not as good a provider as he
is? Is he impugning the majority of the
profession?

I have emphasized to every student and resident I
have ever taught, and there have been many of them
that they must do their best for every patient
they encounter. Is he saying that cash money
drives him to do a better job or that it allows
him to do a better job. He is definitely saying
that every podiatrist who accepts insurance is not
able to render the quality of care he delivers.
It seems he does not care that he has alienated
the majority of our profession and some
extraordinary practitioners with his self-
aggrandizing rhetoric.

Dr. Kornfeld has also made a couple astounding
statements that give pause to reflect on what he
really wants us to take away from the discourse.
He states, “Profit in a podiatry practice should
not be secondary. It needs to be primary. This is
a business. ALTRUISM DOES NOT PAY THE BILLS “(Dr.
Kornfeld’s capitalization). We have been entrusted
with a sacred privilege to care for someone else’s
health and welfare.

In my ethical world the patient and the treatment
I provide comes first. Nothing supplants our care
for the patient who has entrusted their physical
well-being to us. Nothing, simply nothing. When
I walked into the operating room, the rest of the
world was on the other side of those operating
room doors and it remained there. There were no
thoughts about remuneration. If there is the least
bit of conflict or confusion, that person does not
belong in the operating room. The very same holds
true for every person in that operating room. If
profit is the driving force behind one’s day, I
say transition to becoming a stockbroker.

I started this letter using the word meta-ethics
which refers to how and what we think about the
term good. Is “good” simply that which is desired
or desirable? To practice non-maleficence is not
the same as practicing beneficence. Non-
maleficence means to do no harm and beneficence is
our call to do good. The good we are talking about
is not the good of consequentialism but rather an
action that brings about agape. We all must define
what good means and what we mean by doing good,
thus our personal meta-ethic. The process requires
significant and often painful reflection if on is
to be honest with one’s self. After years of
practice it is easy to lie to ourselves and
believe we are practicing virtue.

Patients were referred to me, especially at Ohio
State Medical Center who had no insurance, were
indigent, were infected with HIV and immigrants
from Africa. They had been seen by a local
podiatrist who told them through an interpreter
that Dr. Tomczak has some special equipment at
Ohio State and could better treat that ingrown
toenail. I ask Drs. Roth and Kornfeld to search
your heart of hearts and answer whether or not you
would treat these patients, or as they say in the
vernacular, “Turf them to Tomczak.”

Rod Tomczak, DPM, MD, EdD

There are no more messages in this thread.